ROP APPLICATION

Directions: Please Print Legibly

Anguiano
Maria
Isabel
Name: __________________________________________

(Last)

(First)

04-27-15
____________________

(Middle)

Date

1807 Lopes Ave.

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
Merced
95341
_______________________________________________________________________________

(City)

(State)

(209 ) 205-5686

(Zip Code)

MS102212@hotmail.com
626-0530
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

(Telephone Number)

Position applied for:_______________________________________________________________

Law Internship
Skills and/or competencies which qualify you for this position:
I am smart, friendly and always willing to learn new things.

Spanish
Languages spoken and/or written (other than English):___________________________________

Have you ever been convicted, pleaded guilty or no contest to a misdemeanor or felony?
No

Yes

If yes, explain:________________________________

Do you possess a valid California Drivers License?

No

Yes

_______________________
(Number)

RECORD OF EDUCATION

Name of School
High School

City/State

Course of
study or
major

Last year
completed

Did you
graduate?

Diploma
or degree

Merced High School

N/A

N/A

1 2 3 4

Yes

Diploma

College/
University

N/A

N/A

N/A

1 2 3 4

N/A

N/A

Other
(Specify)

N/A

N/A

N/A

1 2 3 4

N/A

N/A

List appropriate extracurricular activities, clubs, organizations and courses for this position:
I have being part of CSF since my freshmen year as well as to a Peer Mentor since my junior year. As a Peer
Mentor I help students who are not doing well academically and I also hlep special Ed students.
FULL TIME

AVAILABILITY

PART TIME

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

9AM-2PM

8AM-4PM

8AM-PM

8AM-4PM

8AM-4PM

8AM-4PM

8AM-4PM

RECORD OF EMPLOYMENT: (Begin with your most recent job)

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

N/A
N/A
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

N/A

_________________________________________________

To:

N/A
______

N/A
______

Mo / Yr

Mo/Yr

N/A
N/A
Total ____Yrs.
________Mo.
N/A
Hours Per Week:_________
Reason For Leaving:
N/A

From:

_________________________________________________
Supervisors Name:
N/A
_____________________________________________________

_________________________________________________

N/A
Title__________________________Last
Salary: _____________
N/A

_________________________________________________

Duties:

_________________________________________________

N/A

_________________________________________________

To:

N/A
______

N/A
______

Mo/ Yr

Mo/Yr

N/A
N/A
Total ____Yrs.
________Mo.

N/A

Hours Per Week:_________

Reason For Leaving:

N/A

_________________________________________________

N/A

_________________________________________________
Supervisors Name:
N/A
________________________________________________

From:

To:

N/A
______

N/A
______

Mo /Yr

Mo/Yr

N/A
N/a
Total ____Yrs.
________Mo.

N/A

N/A
N/A
Title___________________________Last
Salary: ____________

_________________________________________________

Duties:

_________________________________________________

N/A

_________________________________________________

N/A
Hours Per Week:_________
Reason For Leaving:

_________________________________________________

N/A
Supervisors Name:
N/A
________________________________________________

_________________________________________________

REFERENCES: Give the names of three persons not related to you.

Name
1.

Steven S Mua

Complete Address (Include City, State, Zip)

4734 NHWY 59

Phone

Occupation_______

(209) 631-4769
Teacher

Merced, CA 95348

________________________________________________________________________________________________________________________________
2.

Donna Ramirez

3549 Veranda Ct

(209) 349-8821
Teacher

Merced, CA 95340

________________________________________________________________________________________________________________________________
3. Veronica

Jaramillo

103 MIMI LN

(209) 626- 5645

Merced, CA 95341

Student

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

I understand that misrepresentation or omission of facts is cause for dismissal.

Date:_________________________Signature:_________________________________________________________________